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Pediatric Radiology
Published in: Pediatric Radiology 12/2022

Open Access 07-05-2022 | Child Abuse | Original Article

Prevalence of inflicted and neglectful femur shaft fractures in young children in national level I trauma centers

Authors: Marie-Louise H. J. Loos, Roel Bakx, J. H. Allema, Frank W. Bloemers, Jan A. Ten Bosch, Michael J. R. Edwards, Jan B. F. Hulscher, Claudia M. G. Keyzer-Dekker, Egbert Krug, Victor A. de Ridder, W. Richard Spanjersberg, Arianne H. Teeuw, Hilco P. Theeuwes, Selena de Vries, Ralph de Wit, Rick R. van Rijn, The FurAHA study group

Published in: Pediatric Radiology | Issue 12/2022

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Abstract

Background

The prevalence of inflicted femur fractures in young children varies (1.5–35.2%), but these data are based on small retrospective studies with high heterogeneity. Age and mobility of the child seem to be indicators of inflicted trauma.

Objective

This study describes other factors associated with inflicted and neglectful trauma that can be used to distinguish inflicted and neglectful from accidental femur fractures.

Materials and methods

This retrospective study included children (0–6 years) who presented with an isolated femur fracture at 1 of the 11 level I trauma centers in the Netherlands between January 2010 and January 2016. Outcomes were classified based on the conclusions of the Child Abuse and Neglect teams or the court. Cases in which conclusions were unavailable and there was no clear accidental cause were reviewed by an expert panel.

Results

The study included 328 children; 295 (89.9%) cases were classified as accidental trauma. Inflicted trauma was found in 14 (4.3%), while 19 (5.8%) were cases of neglect. Indicators of inflicted trauma were age 0–5 months (29%, positive likelihood ratio [LR +] 8.35), 6–12 months (18%, LR + 5.98) and 18–23 months (14%, LR + 3.74). Indicators of neglect were age 6–11 months (18%, LR + 4.41) and age 18–23 months (8%, LR + 1.65). There was no difference in fracture morphology among groups.

Conclusion

It is unlikely that an isolated femur fracture in ambulatory children age > 24 months is caused by inflicted trauma/neglect. Caution is advised in children younger than 24 months because that age is the main factor associated with inflicted trauma/neglect and inflicted femur fractures.
Appendix
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Literature
1.
2.
Mitchell IC, Norat BJ, Auerbach M et al (2020) Identifying maltreatment in infants and young children presenting with fractures: does age matter? Acad Emerg Med 28:5–18CrossRefPubMed
3.
Son-Hing JP, Deniz Olgun Z (2018) The frequency of nonaccidental trauma in children under the age of 3 years with femur fractures: is there a better cutoff point for universal workups? J Pediatr Orthop Part B 27:366–368CrossRef
4.
Pandya NK, Baldwin K, Wolfgruber H et al (2009) Child abuse and orthopaedic injury patterns: analysis at a level I pediatric trauma center. J Pediatr Orthop 29:618–625CrossRefPubMed
5.
6.
7.
8.
9.
Driessen MLS, Sturms LM, Bloemers FW et al (2020) The Dutch nationwide trauma registry: the value of capturing all acute trauma admissions. Injury 51:2553–2559CrossRefPubMed
10.
11.
Cepela DJ, Tartaglione JP, Dooley TP, Patel PN (2016) Classifications in brief: Salter-Harris classification of pediatric physeal fractures. Clin Orthop Relat Res 474:2531–2537CrossRefPubMedPubMedCentral
12.
Teeuw AH, Kraan RBJ, van Rijn RR et al (2019) Screening for child abuse using a checklist and physical examinations in the emergency department led to the detection of more cases. Acta Paediatr 108:300–313CrossRefPubMed
13.
14.
15.
Kemp AM, Dunstan F, Harrison S et al (2008) Patterns of skeletal fractures in child abuse: systematic review. BMJ 337:a1518
16.
Coffey C, Haley K, Hayes J, Groner JI (2005) The risk of child abuse in infants and toddlers with lower extremity injuries. J Pediatr Surg 40:120–123CrossRefPubMed
17.
Turner HA, Finkelhor D, Mitchell KJ et al (2020) Strengthening the predictive power of screening for adverse childhood experiences (ACEs) in younger and older children. Child Abus Negl 107:104522
18.
Leventhal JM, Thomas SA, Rosenfield NS, Markowitz RI (1993) Fractures in young children. Distinguishing child abuse from unintentional injuries. Am J Dis Child 147:87–92CrossRefPubMed
19.
Schwend RM, Werth C, Johnston A (2000) Femur shaft fractures in toddlers and young children: rarely from child abuse. J Pediatr Orthop 20:475–481CrossRefPubMed
20.
Worlock P, Stower M, Barbor P (1986) Patterns of fractures in accidental and non-accidental injury in children: a comparative study. Br Med J 293:100–102CrossRef
21.
22.
Mellick LB, Reesor K (1990) Spiral tibial fractures of children: a commonly accidental spiral long bone fracture. Am J Emerg Med 8:234–237CrossRefPubMed
23.
Banaszkiewicz PA, Scotland TR, Myerscough EJ (2002) Fractures in children younger than age 1 year: importance of collaboration with child protection services. J Pediatr Orthop 22:740–744
24.
Ghanem MAH, Moustafa TA, Megahed HM et al (2018) A descriptive study of accidental skeletal injuries and non-accidental skeletal injuries of child maltreatment. J Forensic Leg Med 54:14–22CrossRefPubMed
25.
Wegmann H, Orendi I, Singer G et al (2016) The epidemiology of fractures in infants — which accidents are preventable? Injury 47:188–191CrossRefPubMed
26.
Thompson NB, Kelly DM, Warner WCJ et al (2014) Intraobserver and interobserver reliability and the role of fracture morphology in classifying femoral shaft fractures in young children. J Pediatr Orthop 34:352–358CrossRefPubMed
27.
Loos MHJ, Allema WM, Bakx R et al (2020) Paediatric femur fractures — the value of contextual information on judgement in possible child abuse cases: are we bias [sic]? Eur J Pediatr 180:81–90CrossRefPubMedPubMedCentral
28.
Talbot C, Davis N, Majid I et al (2018) Fractures of the femoral shaft in children: national epidemiology and treatment trends in England following activation of major trauma networks. Bone Joint J 100-B:109–118
29.
Capra L, Levin AV, Howard A, Shouldice M (2013) Characteristics of femur fractures in ambulatory young children. Emerg Med J 30:749–753CrossRefPubMed
30.
Ambrose CG, Soto Martinez M, Bi X et al (2018) Mechanical properties of infant bone. Bone 113:151–160CrossRefPubMed
31.
32.
Van Konijnenburg EMH, Vrolijk-Bosschaart TF, Bakx R, Van Rijn RR (2016) Paediatric femur fractures at the emergency department: accidental or not? Br J Radiol 89:9–12
33.
Pierce MC, Bertocci GE, Janosky JE et al (2005) Femur fractures resulting from stair falls among children: an injury plausibility model. Pediatrics 115:1712–1722CrossRefPubMed
34.
Taitz J, Moran K, O’Meara M (2004) Long bone fractures in children under 3 years of age: is abuse being missed in emergency department presentations? J Paediatr Child Health 40:170–174CrossRefPubMed
35.
Boyce MC, Melhorn KJ, Vargo G (1996) Pediatric trauma documentation. Adequacy for assessment of child abuse. Arch Pediatr Adolesc Med 150:730–732CrossRefPubMed
36.
37.
Lorenz DJ, Pierce MC, Kaczor K et al (2018) Classifying injuries in young children as abusive or accidental: reliability and accuracy of an expert panel approach. J Pediatr 198:144–150.e4CrossRefPubMedPubMedCentral
Metadata
Title
Prevalence of inflicted and neglectful femur shaft fractures in young children in national level I trauma centers
Authors
Marie-Louise H. J. Loos
Roel Bakx
J. H. Allema
Frank W. Bloemers
Jan A. Ten Bosch
Michael J. R. Edwards
Jan B. F. Hulscher
Claudia M. G. Keyzer-Dekker
Egbert Krug
Victor A. de Ridder
W. Richard Spanjersberg
Arianne H. Teeuw
Hilco P. Theeuwes
Selena de Vries
Ralph de Wit
Rick R. van Rijn
The FurAHA study group
Publication date
07-05-2022
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Radiology / Issue 12/2022
Print ISSN: 0301-0449
Electronic ISSN: 1432-1998
DOI
https://doi.org/10.1007/s00247-022-05378-8

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